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DREAM-A-WORLD CULTURAL
THERAPY

Frederick W. Hickling CD, DM, FRSM, FRCPsych, DLFAPA
Caribbean Institute of Mental Health ...
DREAM-A-WORLD CULTURAL
THERAPY

Frederick W. Hickling CD, DM, FRSM, FRCPsych, DLFAPA
Caribbean Institute of Mental Health ...
Cultural therapy, was pioneered at Bellevue
Hospital in 1978

“Madnificent Irations”
A historical pageant of madness in Ja...
Psychiatry in Jamaica has been
assimilated into Primary & Secondary
public health care
Jamaican society – Little Economic growth or development in 50 years

TRANSGRESSIVE
UNPRODUCTIVE
40% ADULTS

RESILIENT PRO...
HOWEVER THE
TRANSGRESSIVE
BEHAVIORAL
UNDERBELLY OF THE
SOCIETY HAS BEEN
EXPOSED:
The third highest murder
rate in the worl...
Jamaican children are suffering

• High physical abuse and neglect
• High rates of sexual molestation
Jamaican children are suffering

• 40% pregnancies under 16 years old
• 50% school dropout rates & illiteracy
Jamaican children are suffering

• High rates of youth aggression &
criminality
MENTAL HEALTH
CHALLENGES FOR THE NEW
MILLENNIUM

• A shift from curative to preventative
mental health care
MENTAL HEALTH
CHALLENGES FOR THE NEW
MILLENNIUM

• Creation of antidotes for conduct and
impulsivity disorders
MENTAL HEALTH
CHALLENGES FOR THE NEW
MILLENNIUM

• Creation of antidotes for anti social
behavior
MENTAL HEALTH
CHALLENGES FOR THE NEW
MILLENNIUM

• Promotion of self-esteem and selfconfidence
A bold new
University of the
West Indies
initiative in
primary mental
health prevention
Caribbean Institute of
Mental heal...
UNIVERSITY OF THE WEST INDIES
CARIBBEAN INSTITUTE OF
MENTAL HEALTH AND
SUBSTANCE ABUSE
(CARIMENSA)

TRAINING

PROOF OF CON...
Recent international studies have demonstrated
that children who cannot read by age 8 are most
likely to become involved i...
ACHIEVEMENT GAP OF CHILDREN IN UK
Carimensa & Allman Town Primary
Dream A World Cultural Therapy
‘Proof of Concept’ 2006
The Dream-A-World Process

• 30 who had failed Grade 3 Test, 30 controls
The Dream-A-World Process

• 40 hour 3-week workshops in summer vacation
The Dream-A-World Process

• 60 hours ‘top-up’ sessions during the term
The Dream-A-World Process

• 240 hours over 2½ years
The Dream-A-World Process

• Annual ‘Show and Tell’ performance
Laminated photo-ID’s boosted self esteem
The Dream-A-World Workshop

• Breakfast and lunch
• Daily literacy & numeracy
The Dream-A-World Workshop

• Psychotherapy ‘small groups’
• Identify things they like in their world
The Dream-A-World Workshop

• Invent a new Planet comprising
things they like - ‘Dream-A-World’
The Dream-A-World Show & Tell Pageant

• Created a play of their new World
• Created songs about their new planet
The Dream-A-World Show & Tell Pageant

• Created costumes and masks
• Performed to their community family
The Dream-A World Cultural Therapy
process:

• Catalyzes the creative imagination
The Dream-A World Cultural Therapy
process:

• Focuses on the drum and
homemade instruments
The Dream-A World Cultural Therapy
process:

• Creates
music, songs, dances, skits
We took the children on field
trips
We taught them to hug
PILOT PROOF OF
CONCEPT RESEARCH
ARTICLE

PILOT PROJECT PROOF OF CONCEPT RESEARCH ARTICLE.
Promoting Resilience in High-ris...
CHANGES IN ASEBA BEHAVIOR
RATINGS OVER THE STUDY PERIOD

Significant improvements in school
social and behaviour adjustmen...
CHANGES IN ASEBA BEHAVIOR
RATINGS OVER THE STUDY PERIOD

Boys received significantly
improved teacher ratings in school
so...
Dream-A-World Cultural
Therapy ‘Scale-up’
intervention for school-aged
high-risk primary school
Jamaican children July 201...
THE ‘SCALE UP’ - TASK SHARING
4 Primary Schools in Seaview Gardens

Dr. Hilary Robertson-Hickling, Principal Mrs. Elaine J...
(Teacher) “… these children they can’t sit still… they can’t
socialize well…they have very short attention span, they are
...
Performers from 4 Primary Schools at
final “Show & Tell” of the 2013 ‘Dream-AWorld Scale Up’ in inner-city Kingston
(Teacher): “…some of them could not spell things as simple
as their names…but then at the end of the program they
were wri...
Scale up & transition to scale

(Psychologist): “…we are now at the 4 scale up but … we have to go to
400. What are the le...
“…Emancipate ourselves from
mental slavery…” Bob Marley
Teaching self control & selfconfidence

Shelly Ann
Fraser-Pryce
Shelly-Ann Fraser-Pryce Jamaica University of
Technology Graduation 2013
One love, brothers and
sisters, one heart, one
destiny
TTWUD - Dream A World Cultural Therapy - Frederick Hickling
TTWUD - Dream A World Cultural Therapy - Frederick Hickling
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TTWUD - Dream A World Cultural Therapy - Frederick Hickling

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TTWUD - Dream A World Cultural Therapy - Frederick Hickling

  1. 1. DREAM-A-WORLD CULTURAL THERAPY Frederick W. Hickling CD, DM, FRSM, FRCPsych, DLFAPA Caribbean Institute of Mental Health & Substance Abuse (CARIMENSA), University of the West Indies. Mona, Jamaica. Turning The World Upside Down, London , November 27, 2013
  2. 2. DREAM-A-WORLD CULTURAL THERAPY Frederick W. Hickling CD, DM, FRSM, FRCPsych, DLFAPA Caribbean Institute of Mental Health & Substance Abuse (CARIMENSA), University of the West Indies. Mona, Jamaica. Turning The World Upside Down, London , November 27, 2013
  3. 3. Cultural therapy, was pioneered at Bellevue Hospital in 1978 “Madnificent Irations” A historical pageant of madness in Jamaica
  4. 4. Psychiatry in Jamaica has been assimilated into Primary & Secondary public health care
  5. 5. Jamaican society – Little Economic growth or development in 50 years TRANSGRESSIVE UNPRODUCTIVE 40% ADULTS RESILIENT PRODUCTIVE 60% ADULTS ? HEALTHY PRODUCTIVE ADOLESCENTS MENTALLY UNHEALTHY DISRUPTIVE ADOLESCENTS DREAM-A-WORLD CULTURAL THERAPY Healthy resilient reading by age 8 Disruptive, underperforming NOT reading by age 8 CHILDREN 0-3: - Economic & social inequality; high viability, high risk
  6. 6. HOWEVER THE TRANSGRESSIVE BEHAVIORAL UNDERBELLY OF THE SOCIETY HAS BEEN EXPOSED: The third highest murder rate in the world Krause, K., et al (2011). The third lowest suicide rate in the world Abel, W., et al (2007)
  7. 7. Jamaican children are suffering • High physical abuse and neglect • High rates of sexual molestation
  8. 8. Jamaican children are suffering • 40% pregnancies under 16 years old • 50% school dropout rates & illiteracy
  9. 9. Jamaican children are suffering • High rates of youth aggression & criminality
  10. 10. MENTAL HEALTH CHALLENGES FOR THE NEW MILLENNIUM • A shift from curative to preventative mental health care
  11. 11. MENTAL HEALTH CHALLENGES FOR THE NEW MILLENNIUM • Creation of antidotes for conduct and impulsivity disorders
  12. 12. MENTAL HEALTH CHALLENGES FOR THE NEW MILLENNIUM • Creation of antidotes for anti social behavior
  13. 13. MENTAL HEALTH CHALLENGES FOR THE NEW MILLENNIUM • Promotion of self-esteem and selfconfidence
  14. 14. A bold new University of the West Indies initiative in primary mental health prevention Caribbean Institute of Mental health & Substance Abuse (CARIMENSA)
  15. 15. UNIVERSITY OF THE WEST INDIES CARIBBEAN INSTITUTE OF MENTAL HEALTH AND SUBSTANCE ABUSE (CARIMENSA) TRAINING PROOF OF CONCEPT EVIDENCED BASED OUTCOMES SCALE UP SERVICES GOVERNMENTAL ORGANIZATIONS (Health, Educatio n, Security etc) NGO’S TRANSITION TO SCALE
  16. 16. Recent international studies have demonstrated that children who cannot read by age 8 are most likely to become involved in high risk behaviors. Huesmann LR, Eron LD, & Yarmel PW, 1987
  17. 17. ACHIEVEMENT GAP OF CHILDREN IN UK
  18. 18. Carimensa & Allman Town Primary Dream A World Cultural Therapy ‘Proof of Concept’ 2006
  19. 19. The Dream-A-World Process • 30 who had failed Grade 3 Test, 30 controls
  20. 20. The Dream-A-World Process • 40 hour 3-week workshops in summer vacation
  21. 21. The Dream-A-World Process • 60 hours ‘top-up’ sessions during the term
  22. 22. The Dream-A-World Process • 240 hours over 2½ years
  23. 23. The Dream-A-World Process • Annual ‘Show and Tell’ performance
  24. 24. Laminated photo-ID’s boosted self esteem
  25. 25. The Dream-A-World Workshop • Breakfast and lunch • Daily literacy & numeracy
  26. 26. The Dream-A-World Workshop • Psychotherapy ‘small groups’ • Identify things they like in their world
  27. 27. The Dream-A-World Workshop • Invent a new Planet comprising things they like - ‘Dream-A-World’
  28. 28. The Dream-A-World Show & Tell Pageant • Created a play of their new World • Created songs about their new planet
  29. 29. The Dream-A-World Show & Tell Pageant • Created costumes and masks • Performed to their community family
  30. 30. The Dream-A World Cultural Therapy process: • Catalyzes the creative imagination
  31. 31. The Dream-A World Cultural Therapy process: • Focuses on the drum and homemade instruments
  32. 32. The Dream-A World Cultural Therapy process: • Creates music, songs, dances, skits
  33. 33. We took the children on field trips
  34. 34. We taught them to hug
  35. 35. PILOT PROOF OF CONCEPT RESEARCH ARTICLE PILOT PROJECT PROOF OF CONCEPT RESEARCH ARTICLE. Promoting Resilience in High-risk Children in Jamaica: A Pilot Study of a Multimodal Intervention Jaswant Guzder MD, FRSPC; Vanessa Paisley MSc; Hilary RobertsonHickling PhD; Frederick W. Hickling DM, FRCPsych (UK), DLFAPA Abstract Objective: To assess the effectiveness of a multimodal afterschool and summer intervention called the Dream-A-World (DAW) Project for a cohort of school-aged Jamaican children from an impoverished, disadvantaged inner-city community in Kingston, Jamaica. Children were selected by their teachers based on severe disruptive disorders and academic underachievement and compared with a matched control group. The pilot was a child focused therapeutic modality without parental intervention for disruptive conduct and academic failure. Method: A group psychotherapeutic Jaswant Guzder intervention of creative arts therapies and remedial academic support adapted for the Jamaican context was implemented with 30 children from an inner-city primary school. The intervention was implemented over 21⁄2 years spanning grade three to six with evaluation of outcomes using the ASEBA TeacherVanessaForm (TRF) and end of term Report Paisley grades for the intervention group versus matched controls who were offered usual school supports. Results: The intervention group made significant improvements in school social and behavior adjustment measuredH Robertson- more successful outcome amongst boys for by the TRF, with behavioral gains. No significant improvements were made by the girls. Hickling Limitations of cohort size, lack of parent data and questions of gender disparities in outcome were unresolved interpretative issues. Conclusion: This multi-modal mental health and academic Fred Hickling intervention for high-risk children living in an impoverished, violent neighbourhood, improved global functioning of boys more than girls, and raised questions for design of further preventive planning. Journal of the Canadian Academy of Child and Adolescent Psychiatry, May 2013
  36. 36. CHANGES IN ASEBA BEHAVIOR RATINGS OVER THE STUDY PERIOD Significant improvements in school social and behaviour adjustment compared with controls
  37. 37. CHANGES IN ASEBA BEHAVIOR RATINGS OVER THE STUDY PERIOD Boys received significantly improved teacher ratings in school social and emotional adjustment than the girls.
  38. 38. Dream-A-World Cultural Therapy ‘Scale-up’ intervention for school-aged high-risk primary school Jamaican children July 2013
  39. 39. THE ‘SCALE UP’ - TASK SHARING 4 Primary Schools in Seaview Gardens Dr. Hilary Robertson-Hickling, Principal Mrs. Elaine Jones, Dr. Duncan Pedersen
  40. 40. (Teacher) “… these children they can’t sit still… they can’t socialize well…they have very short attention span, they are underdeveloped…they are not alert...”
  41. 41. Performers from 4 Primary Schools at final “Show & Tell” of the 2013 ‘Dream-AWorld Scale Up’ in inner-city Kingston
  42. 42. (Teacher): “…some of them could not spell things as simple as their names…but then at the end of the program they were writing the names of their school, and their own names clearly… in 3 weeks…”
  43. 43. Scale up & transition to scale (Psychologist): “…we are now at the 4 scale up but … we have to go to 400. What are the lessons learned …when you now have the expansion from 1 to 40 or 400... There is still a lot to learn and we are going to have to learn it quickly …”
  44. 44. “…Emancipate ourselves from mental slavery…” Bob Marley
  45. 45. Teaching self control & selfconfidence Shelly Ann Fraser-Pryce
  46. 46. Shelly-Ann Fraser-Pryce Jamaica University of Technology Graduation 2013
  47. 47. One love, brothers and sisters, one heart, one destiny

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